Obesity: The Post Mortem Page #4

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What there does seem to be,

and which should be evident now

if I pick this lung up and squeeze it,

is you can see the fluid dripping out

of these lungs

and this is what we call pulmonary oedema,

that's essentially heart failure fluid,

this fluid is basically water.

I know it looks red,

thats because obviously it's within the

body and it's been mixed with blood.

This isnt... Blood is much, much

thicker than that.

This is really just a watery fluid,

and this has collected because

this lady has got heart failure.

This lady died from heart failure,

from hypertensive heart disease,

but this lady is also obese.

She did not die from the obesity.

The obesity increased the risk factors

and was associated with the problems

that led to her death.

Fluid has built up in this ladys lungs

because her heart isnt working properly.

Shed have probably been short of breath

and possibly had a cough.

But also because the fluid sits

in the chest when you lie flat,

and that would have given her a sensation

almost of drowning.

When you become a doctor,

one of the questions that they teach you

very early on is, how many pillows

do you sleep with?

And that tends not to because they are

asking how comfortable you are at night,

its because if somebody says, "Oh,

I cant sleep in a bed, Doctor,

I have to sleep in a chair or I have to

sleep with eight pillows sitting up,"

that is very indicative of heart failure.

[Vinette] From the startling discovery

Mike has made in our donor's lungs,

we now know that she would have

felt the impact of her obesity

and heart failure every single day.

[Michael] Heart failure is not the same

as a heart attack.

When a heart fails, it doesnt fail

immediately in this type of circumstance.

It fails over a long period of time,

so the symptoms are gradual,

so this lady may have been able to walk

up ten flights of stairs

three years ago,

then she suddenly found she got very

breathless after five flights of stairs,

then she found it very, very difficult to

even walk up one flight of stairs

or even carry her shopping.

It would have been a progressive disease

as the heart became worse and worse

and worse. Now the final event, obviously,

when this ladys heart stopped working,

that would have been

an instantaneous event

that led to her death.

[Vinette] Now its time for Mike

to examine

in detail the organ that catastrophically

failed in our donor.

What will we find out about how

and why she might have died?

You cant really see the heart yet because

the heart is sitting in a bag.

This is called the pericardial sack.

Just going to open that.

And so I can reflect that back,

and thats the heart there,

so the heart now is in my hand

and you can see all the fat

I was talking about earlier

really isnt around the heart,

it's really around the pericardium.

There is a bit of fat around the heart,

which is here,

this is absolutely typical

in everybodys heart,

even a thin persons heart

would have this,

and Im going to cut off

the pericardial sack.

This big blood vessel here is the aorta.

This is the vessel that takes all the

blood from the heart around the body.

When I feel this heart, it feels baggy.

The heart in somebody

who is very athletic,

their heart would be very tight,

very firm,

it would be like almost picking up a

piece of steak. This is more like a bag.

What Im going to do now

is weigh this heart.

So this heart is

449 grams.

That's a heavy heart. This lady

is, despite her weight,

this lady is actually

quite a petite person.

So you would expect her heart

to be perhaps 275 grams.

Something like that. So this is very

much heavier than you would expect.

And that is the sort of size heart

you would expect

in someone who has got

heart failure

due to high blood pressure

which is what this lady suffered from.

The heart basically has to pump

to keep up the pressure,

the heart gets bigger

and bigger and bigger,

but there becomes a point where

the heart cant get any bigger

and it basically exhausts itself.

[Vinette] Now that he has discovered

the shocking state of our donor's heart,

Mike wants to look at it from the inside.

He cuts some slices so he can

examine the ventricles, the walls

of the heart that pump the blood.

If youre a 6'8" All Black second row,

you're, you know,

one of the professional footballers

running around the pitch,

you need a lot of blood,

so the wall of the left ventricle

in a young, fit person,

is usually an inch-thick muscle

all the way around.

Now if you look at this lady,

this ladys left ventricle

is very, very thin. This is eight

millimetres, something like that.

That is because she developed high blood

pressure to start off with,

the heart had to pump harder and harder,

but in the end, what you get to is a state

where the muscle cant keep

the high blood pressure up

and it starts to get thinner and

thinner and thinner and basically

you go from a thick muscular pump

through to a paper bag that's not capable

of pumping blood adequately

around the body. And we see

a lot of these hearts.

We see them on a background

of hypertension.

This is a common finding and

becoming more common.

Hypertension is high blood pressure.

Obesity is well known to be one

of the major risk factors

for high blood pressure,

so in this lady

they were not able to control that

and that led to changes within the heart

which meant the heart failed,

it couldnt work properly

and that is what this lady died from.

[Vinette] Obesity is a killer.

Not by itself,

but in the many ways that it triggers

and accelerates disease.

But so much of the way that we think about

fat isn't medical at all, it's personal.

I have been fat all my life

and its never been a positive

thing for me.

Ive always associated it with something

negative to be honest.

I feel like fat is a filter

through which I'm seen because

there are certain stereotypes

that go alongside being fat,

being overweight,

that maybe people who are overweight

are lazy or not very clever.

I dont know where those have come from,

but I feel like I have to try extra hard

to prove those things wrong.

I don't think I necessarily would

associate my fat with being invited

to get together with friends or going out,

but, you know, if they were going to

play a game of football or rugby,

they might think twice.

Socially, in terms of relationships,

definitely has.

I mean, you go into a bar and you look

like a GQ cover model versus me,

the girl is always going to go

for the GQ cover model,

sadly, and try as I might

to be the funny fat guy.

You try to build this wall,

this wall that, you know,

you just sort of try to ignore it,

and from strangers you can because

you think, well, they dont know me,

but when somebody who is supposed

to love you and

somebody who supposed to care for you

and accept you for who you are,

when they call you fat, just to...

The feeling is just horrible.

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